MPs, support the care bill and it will come back to bite you

Even when a hospital is solvent, Jeremy Hunt's clause 119 would let administrators cannibalise it to fix failing institutions elsewhere

Millwall players support Lewisham hospital: 'Lewisham hospital was fine, financially and clinically, but when the South London Healthcare Trust went bankrupt, partly due to a PFI, its administrator tried to kidnap Lewisham's A&E and maternity services.' Photograph: Tom Jenkins Tom Jenkins/Tom Jenkins

A panic measure in the Commons today faces a cross-party rebellion. When MPs debate clause 119, hastily tacked on to the care bill, Labour will be joined by a bunch of Lib Dems and maybe some Tories seeking to strike it out. The clause lets trust special administrators (TSAs) close down any hospital or A&E at 40 days' notice – with no meaningful consultation to stop objections until it's all over.

Every MP should consider carefully how they vote today as this may come back and bite them hard in their own backyard. If a hospital is in financial trouble, clause 119 gives a TSA special administrative powers not just to close, merge or alter the troubled hospital – astonishingly, it gives a TSA the power to cannibalise any other thriving hospital to seize profitable services to plug the cash gap, regardless of local social and health effects. Unsuspecting MPs who think their own hospital is financially hunky dory should watch out: clause 119 lets an administrator grab juicy slices to fix a distant bankruptcy.

Health secretary Jeremy Hunt was thwarted in his attempt to do that in Lewisham, so this new clause gives him the power. Lewisham hospital was fine, financially and clinically, but when the South London healthcare trust went bankrupt, partly due to a PFI, its administrator tried to kidnap Lewisham's A&E and maternity services. The protest from Lewisham's doctors, public and mayor led to the court of appeal rejecting the plan. Clause 119 is Hunt's retaliation, allowing future administrators to seize a whole area's services. Even the local clinical commissioning groups will have no say over the fate of services they commission: so much for putting GPs in control.

Don't imagine this extreme power is just for a few basket-cases. The financial crisis now gripping the NHS reveals the alarming number of trusts with soaring debts. Half the acute trusts under the Trust Development Authority are in trouble, alongside 39 of the 100 foundation trusts. Labour today lists 32 trusts forecasting the worst deficits, which MPs should study carefully: a TSA may lean across the border and grab a chunk from a healthy service to plug a gap elsewhere. When that happens and there's an outcry, you can bet angry local campaigners will ask their MP how they voted today. Did they vote for these draconian powers? If so, they'll feel the heat when local objectors find the 40-day axe falls before they can paint a "Save our A&E" banner.

Hunt needs this power to patch up erupting crises in NHS finances. Can he stop outbreaks before the election? He's been lucky with the weather – no flu, no norovirus – and lucky that NHS staff and managers strive to do the virtually impossible. If his party wins, his reward will be an escape from the department before the entire edifice crashes in.

Never has the NHS been under such pressure, says the King's Fund, while the Institute for Fiscal Studies says, once adjusted for age, the NHS is being cut by 9% between 2010 and 2019. Suffering five years of annual 4% "efficiency saving" cuts, with the same for another five years to come, it has a £30bn funding gap.

Do please read these numbers: the better care fund sliced off another £2bn for local authorities to fill the care gap caused by council cuts. Public health money was diverted to councils but, not ringfenced, some slid elsewhere. Everyone calls for community care, but Age UK says 800,000 fewer people get any council care. Nor can GPs fill the gap, their funding cut by a fifth in nine years, while NHS England admits a need for 16,000 more GPs. In hospitals the "tariff deflator" shrinks fee every year: the mental health trusts' fees are cut by a further 20% – so forget its promised "parity of esteem". Then add in a 23% baby boom in maternity units. Meanwhile, PFIs from Labour's era drag down some hospitals.

Now put the NHS in the pressure-cooker after the Francis report on Mid Staffs rightly raised the bar on quality. The bullying culture that starts with Hunt calling round to frighten hospitals breaching waiting times sends threats thundering down the ranks. Fifty Care Quality Commission inspectors arrive in coaches to grill hospitals, inspectors themselves terrified of missing bad care and taking the blame of the old CQC regime.

A few weeks ago, Hunt proudly showed me his noticeboard listing every "never event": I asked where was the other board listing "brilliant events"? But his political game is blaming everyone else by what he calls "lifting the bonnet" on bad care, so stories of blunders distract from the financial crisis. Cameron's eye-catchers for party conference promised seven-day hospitals and seven-day 8am-8pm GP hours – but with no money or plan. In real-world A&Es – most losing money – over 5,000 people a week wait on trolleys for between four and 12 hours. How does it help to impose a fine of £1,000 for every patient waiting an hour over target? David Flory, head of the Trust Development Agency, recently told the King's Fund of his alarming trouble in recruiting CEOs and finance directors. Too few are willing in this climate of blame to take on "jobs people used to queue round the block for".

After the Lewisham debacle, the special administrator concerned says he needed these new draconian powers when he found himself "on a burning platform", where the bankrupt trust was haemorrhaging money by the week. That's a useful image for much of the NHS, worsening year by year. Of course, some parts of the NHS are better run than others, but debts vary for myriad, complex reasons.

A duty of candour is added to the care bill, obliging hospitals to reveal anything that goes wrong to add to Hunt's shame lists. What is not added is Robert Francis's recommendation in his report that all professionals and managers speak out candidly when funds can't cover safe care: "To pretend an acceptable level of service can be delivered when it is not possible to do so is to deceive patients and the public." When under-resourced, "all professionals involved need to make their voice on behalf of patients heard loud and clear". Hunt needs a duty of candour to the public about NHS funding.

Nothing can ever be set in aspic. NHS services always need updating. But the cure for the cash crisis is not haphazard hatcheting of services with no time for examining evidence, consulting commissioners or the public. MPs should think carefully what may befall them if they vote for this today, only to find the axe fall arbitrarily on their own apparently thriving hospitals.

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